Journal of Telemedicine and Telecare最新文献

Virtual Care (VC) enables clinicians to remotely assess and manage healthcare needs. While many healthcare services have integrated virtual components into existing in-person care models, the COVID-19 pandemic prompted organisations worldwide to rapidly develop new VC services from the ground up. This article outlines the establishment of a statewide adult urgent VC Service, detailing its conception, development and the first 6 months of operations. The conceptual phase (7 weeks) involved the project team collecting data and insights from stakeholders to build a business case for the VC Service, with a focus on two referral pathways. The development phase (7 weeks) included creating the model and establishing infrastructure, a workforce, and governance to ensure a high-quality, timely and safe service. The initial operations phase (26 weeks) fully integrated the first two referral pathways. During this time, the leadership team completed recruitment, developed a learning system, expanded operating hours and built a model to expand its referral pathways. The leadership team plans to enhance VC by improving assessment capabilities and by enabling new referral pathways into settings such as aged care. Including research methods in this model is essential to capture the benefits and risks associated with these important changes in healthcare delivery.

ObjectiveAtrial fibrillation (AF), the most common type of arrhythmia, significantly impacts patients' prognosis. While wearable devices are increasingly integrated into cardiovascular monitoring, their effect on clinical outcomes in AF remains unclear. This review demonstrates the impact of wearable technology on major adverse cardiovascular events (MACEs) and assesses its role in AF management and prognosis.MethodsA systematic literature search was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines across PubMed, Embase, Web of Science, and the Cochrane Library databases. Included studies investigated AF patients using wearable devices and reported clinical outcomes. Evidence quality was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation framework. Statistical analyses were performed using R 4.4.2 and Review Manager 5.4.ResultsEleven articles were included in this meta-analysis, comprising 10 studies (seven randomized controlled trials and three observational studies). Compared with usual care, wearable devices uses significantly reduced risks of MACEs (risk ratio [RR], 0.66; 95% confidence interval [CI], 0.47-0.93), all-cause mortality (RR, 0.49; 95% CI, 0.29-0.85), ischemic stroke (RR, 0.13; 95% CI, 0.07-0.26), bleeding events (RR, 0.48; 95% CI, 0.33-0.70), and hospitalization (RR, 0.85; 95% CI, 0.74-0.97). Subgroup analyses suggested that the composite endpoint definitions and follow-up duration primarily explained heterogeneity. Evidence certainty ranged from high to low across outcomes. Sensitivity analysis confirmed the robustness of the findings for MACEs and hospitalization outcomes.ConclusionWearable devices for cardiac monitoring significantly reduce the MACEs risk and improve prognosis in AF patients. This review supports the effectiveness of wearable technology in AF management.

Previous investigations of work-related musculoskeletal disorders (WMSDs) and proper ergonomics in physicians have largely focused on interventionalists and surgeons, given the nature of their jobs. However, with the societal shift toward increased desk work and the widespread adoption of telemedicine, it is essential to examine the ergonomic challenges associated with remote care. Understanding and addressing these factors is critical to prevent musculoskeletal (MSK) strain among physicians and to ensure they can continue delivering high-quality patient care in the long run. Therefore, the goal of this review is to summarize recent interventions targeting ergonomic workspace improvements to mitigate WMSD in physicians practicing telemedicine. A database search was conducted in August 2024 using PubMed, Embase, CINAHL, and Scopus. Studies published in the last 15 years were included if they examined adults in interventional designs measuring musculoskeletal outcomes or sitting time. A total of 47 studies met the inclusion criteria, exploring various ergonomic interventions including: ergonomic training, active workstations, exercise programs, standing desks, backrests, ergonomic chairs, forearm supports, head-alignment devices, and biofeedback devices. Most studies had a positive impact on WMSD. This review highlights the importance of integrating movement, posture optimization, and personalized workspace adjustments to alleviate MSK discomfort and enhance workplace health for physicians.

BackgroundDigital health literacy (DHL) is essential for ensuring effective, safe, and equitable healthcare delivery. Understanding the DHL levels of healthcare professionals and the factors shaping them is critical for guiding workforce development and managing digital transformation processes. This study aimed to identify determinants of DHL among healthcare professionals and examine their implications from a managerial perspective.MethodsA systematic review was conducted following PRISMA guidelines on August 13 to 14, 2024. Web of Science, Scopus, PubMed, MEDLINE, and CINAHL were searched without time restrictions using terms such as "digital health literacy," "e-health literacy," and terms related to healthcare professions, yielding 2702 records. Peer-reviewed full-text studies in English involving healthcare professionals were included, while non-research articles and studies on non-healthcare populations were excluded. Screening and selection were performed independently by two reviewers.ResultsEleven studies published between 2022 and 2024 were included. Content analysis identified several determinants of DHL, including education level, professional experience, access to digital infrastructure, and technological competence. Younger professionals tended to report higher DHL, while more experienced staff demonstrated strong adaptability when required by evolving clinical processes. Some studies noted that digital health tools could create time pressures and affect communication with patients, potentially hindering effective DHL use.ConclusionsStrengthening DHL among healthcare professionals is essential for optimising healthcare quality, safety, and operational efficiency. Integrating digital health competencies in undergraduate curricula, providing role-specific training, and implementing organisational strategies that support digital adoption are key priorities. Although this review is based on a limited number of heterogeneous studies, it provides important insights and highlights the need for more robust and standardised research on DHL in healthcare settings.

BackgroundCardiovascular diseases (CVDs) are a leading cause of morbidity and mortality worldwide and in Australia. Although self-care is essential for CVD management, many individuals face barriers such as complex treatment regimens, limited health literacy, and lack of culturally appropriate support. Conversational agents (CAs) offer a promising solution by providing AI-driven, voice-based support that enables human-like interaction. However, most existing CAs primarily target mainstream populations, overlooking the needs of culturally and linguistically diverse communities. This study aimed to co-design and develop Diaspora Engaged Self-care Intervention (DESI-Heart), a culturally tailored CA to support self-care among individuals with CVDs from the Indian diaspora in Australia.MethodsA participatory co-design study was conducted with members of the Indian diaspora in Australia living with Three online workshops were conducted using established design methods, including the 'think-aloud' approach, 'bento-box reflections', and the 'MoSCoW' method, to capture user preferences and inform culturally responsive intervention features. Workshop recordings were transcribed and thematically analysed using NVivo.ResultsOverall, the study included 15 individuals (aged ≥18 years) and identified six themes identified through the co-design process, which informed the design and key features of the DESI-Heart program. The themes included: (1) cultural context of self-care and unique ideas for the DESI-Heart program, (2) medication management features, (3) culturally appropriate dietary support, (4) physical activity support, (5) mental wellbeing support, and (6) user experience and implementation considerations.ConclusionsThis study provided insights into the needs of culturally and linguistically diverse populations, helping address cultural and linguistic barriers and inform the development and feasibility testing of the DESI-Heart program.

Introduction: Children and adolescents with cerebral palsy (CP) demonstrate proficient function if they can perform all tasks required for daily living. Telerehabilitation (TR) and monitoring can facilitate the execution of home-based (HB) therapies. This systematic review aimed to assess the scientific evidence regarding the effects of TR-monitored HB therapies on outcomes related to upper extremity function in children and adolescents with unilateral cerebral palsy (UCP).MethodsComprehensive searches were conducted across online databases, including the Cochrane Library, EMBASE, PubMed, Web of Science, and PEDro, as well as additional sources, from inception to October 2025. The inclusion criteria encompassed randomized controlled trials, whose risk of bias and methodological quality were evaluated using the Cochrane Risk-of-Bias Tool and the PEDro scale, respectively. A narrative synthesis approach was employed for data analysis.ResultsTR-monitored HB therapies showed positive improvements in hand coordination, dexterity, bimanual hand function, ADL motor and processing skills, occupational performance, and execution of functional goals in children and adolescents with UCP (predominantly spastic UCP studies) compared with the control interventions.ConclusionsTelerehabilitation-monitored HB therapies showed potential to improve upper extremity function-related outcomes in children and adolescents with unilateral cerebral palsy (predominantly spastic UCP studies).

IntroductionAntibiotic resistance is a growing public health threat, resulting in challenges in effectively treating bacterial infections. Primary care providers account for the majority of antibiotic prescriptions, highlighting their critical role in antimicrobial stewardship. As telemedicine becomes more prevalent in primary care, there is limited data on how this shift has influenced antibiotic prescribing behavior. Our objective was to examine differences in antibiotic prescription rates for upper respiratory infections (URIs) between in-person and telemedicine appointments in a large primary care health system.MethodsIn this retrospective cohort study, we included patients 18 years and older treated in primary care clinics in the Greater Atlanta area from May 2020 to September 2023. Eligible encounters were billed with a diagnostic code related to URI. The main measures included patient demographics, insurance status, and visit modality. A multivariable logistic regression model evaluated differences in antibiotic prescriptions by visit type.ResultsThere were 33,008 (66%) in-person visits and 16,965 (33.9%) telemedicine visits, totaling 49,973 encounters. The average age of patients was 56.8 (SD 17.5) years, 67.1% patients were female, and 37.6% were Black. There were no significant differences in antibiotic prescribing between telemedicine and in-person appointments (adjusted odds ratio 1.00, 95% CI 0.14-4.86, P > 0.5).DiscussionRates of antibiotic prescribing did not differ significantly between in-person and telemedicine primary care visits for URI. As a healthcare quality indicator, this result provides evidence that in-person and telemedicine appointments are comparable modalities of patient care.

BackgroundStudies show satisfaction with telemedicine, but there is limited data regarding changes in provider practices and clinical outcomes. We sought to evaluate the impact of telehealth on patient-provider communications between visits and clinical outcomes in patients with cirrhosis during the COVID-19 pandemic.MethodsSingle-center retrospective study of cirrhotic patients seen outpatient in 2019 and 2020 was conducted. Clinical characteristics, provider practices, and clinical outcomes were obtained. Provider practices included medication adjustments, labs ordered, and patient communication. Clinical outcomes included ED visits, hospitalizations, and mortality.ResultsTotally, 1395 patients were included with a mean age of 61, 51% female, and 73% Caucasian. The median baseline model for end-stage liver disease (MELD-Na) score was 10. During 2019 there were no telehealth visits. In 2020, 37% of clinic visits were telehealth and 64% of patients had at least one telehealth visit. The rate of medication changes significantly decreased in 2020. There was no significant difference in number of clinic visits, labs ordered, emergency department visits, hospitalizations, or intensive care unit (ICU) stays between 2019 and 2020. In 2020, the rate of telephone contacts and patient messages significantly increased. Compared to 2019, the odds of death were 2.6 times higher in 2020.ConclusionWhen a majority of cirrhotic patients had a telehealth visit, patients had similar rates of emergency department visits, hospitalizations, and ICU stays, but a higher rate of mortality compared to patients with in-person visits. Telehealth was associated with more patient contact between visits, increasing communication demands on providers.

BackgroundPatients with supraglottic laryngeal carcinoma need to receive swallowing rehabilitation training. During the COVID-19 pandemic, patients do not have the conditions to visit the hospital for follow up frequently, so it is imperative to explore a new remote rehabilitation training model based on network conditions.ObjectiveTo explore the effect of remote rehabilitation training mode on improving postoperative swallowing function in patients with supraglottic laryngeal carcinoma.MethodsPatients undergoing remote rehabilitation and video rehabilitation after surgical treatment for supraglottic laryngeal cancer, 16 each, were collected, and swallowing function at the start of transoral feeding was assessed as a baseline to compare swallowing function and the occurrence of complications at different stages of training.ResultsPatients in the remote group began to show significant improvement in subjective swallowing function from the second week (P < .001). In terms of objective swallowing function, although the remote group did not show a significant (P = .66) advantage initially, it was also significantly better than the control group in the fourth week (P＜.001). These effects are even more impressive in patients undergoing open surgery (P＜.001). When completed the rehabilitation phase, patients in the remote group had a better nutritional status (P = .03), especially postlaser surgery patients (P = .02).ConclusionsThe remote rehabilitation training model has an improving effect on patients with supraglottic laryngeal cancer postoperative swallowing disorder, which provides a theoretical basis for the design and improvement of the future remote rehabilitation training model. This study suggests that this training model should be incorporated into the daily postoperative management of patients with laryngeal cancer to improve the efficiency of patients' recovery, provide patients with real-time medical information, and relieve patients' anxiety, thus reducing the need for repeated visits and improving patients' postoperative quality of life.

ObjectiveThis study aimed to develop the Intelligent HOme-based Palliative care for End-of-life (I-HOPE) system, a WeChat mini-program designed to provide home-based palliative care (HBPC), including education, interaction, and social resource access for users.MethodsA mixed-method approach was employed to ensure a comprehensive exploration of user needs, system design, and evaluation. This approach integrated qualitative and quantitative methods, rapid prototyping, expert consultations, and co-design methodologies informed by social ecological theory. Four key stakeholder groups i.e. patients, caregivers, healthcare professionals, and the general public were included. Initially, field research and surveys were conducted to assess the palliative care needs of patients and caregivers. Based on these findings, the mini-program was developed in collaboration with a technical team specializing in healthcare technology. Usability, user experiences, and suggestions for improvement were then collected. This study was conducted in three tertiary hospitals and two community health service centers in Beijing, China.ResultsThe I-HOPE system achieved a System Usability Scale score of 71.89 ± 13.85. User feedback on version 1.0 led to improvements in interface design, features, information presentation, usability, and privacy protection.ConclusionThe development of the I-HOPE system represents an advancement in enhancing the accessibility and quality of HBPC. Future research should focus on identifying areas for further development and assessing its impact on palliative care outcomes.